Provider Demographics
NPI:1184996084
Name:COOPER, EDNA ANN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:EDNA
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 OLD HWY 29
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-8703
Mailing Address - Country:US
Mailing Address - Phone:706-680-9064
Mailing Address - Fax:
Practice Address - Street 1:6300 SAGEWOOD DR
Practice Address - Street 2:SUITE H423
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7502
Practice Address - Country:US
Practice Address - Phone:888-499-4904
Practice Address - Fax:435-658-4954
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001141224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant